Middlesex-London Board of Health Roles and Responsibilities Presentation to Community Services Committee April 23, 2012 Health Protection and Promotion Act (HPPA) 1
Board of Health Composition Health Protection and Promotion Act Section 48 There shall be a board of health for each health unit. R.S.O. 1990,c.H.7,s.48 Section 49 (1) A board of health is composed of the members appointed to the board under this Act and the regulations R.S.O. 1990,c.H.7,s.40 (1) Board Composition 3 City Council Appointees 3 County Council Appointees 5 Provincial Appointees Board of Health 2012 2
Board of Health Duties and Responsibilities Section 4 of HPPA Every board of health, (a) shall superintend, provide or ensure the provision of the health programs and services required by this Act and the regulations to the persons who reside in the health unit served by the board; and (b) shall perform such other functions as are required by or under this or any other Act. R.S.O. 1990, c. H.7, s. 4. HPPA Section 5 Mandatory Health Programs and Services Community Sanitation Control of Infectious Diseases and Reportable Diseases Health Promotion, Health Protection, and Disease and Injury Prevention Family Health HPPA Section 7 (1) The Minister may publish guidelines for the provision of mandatory health programs and services and every board of health shall comply with the published guidelines. R.S.O. 1990,c.H.7,s.7(1) 3
Ontario Public Health Standards A Foundational Standard 13 Program Standards (5 program areas): Chronic Disease & Injury Prevention Family Health Infectious Diseases Environmental Health Emergency Preparedness 25 Protocols Ontario Public Health Standards Format Goal Societal Outcomes Board of Health Outcomes Assessment and Surveillance Health Promotion and Policy Disease Prevention Health Protection 4
Ontario Public Health Organizational Standards Define 44 specific management and governance requirements for all boards of health Board of Health Mandate Other Legislated Duties 1. Health Protection and Promotion Act - Regulations 2. Smoke Free Ontario Act 3. Immunization of School Pupils Act 4. Safe Drinking Water Act Board of Health Funding 5
Board of Health Cost-Shared Programs 100% Programs Cost-Shared Programs 100% Programs Calendar year programs: Mandatory Programs VBD Program CINOT Small Drinking H2O Systems VBD Vector-Borne Disease CINOT Children In Need of Treatment (Dental) HBHC Healthy Babies, Health Children Program MHLTC Ministry of Health and Long-Term Care MCYS Ministry of Children and Youth Services Calendar year programs: Infectious Disease Control (MHLTC) Smoke Free Ontario (MHLTC) Healthy Communities (MHLTC) HBHC (MCYS) Healthy Smiles Ontario (MHLTC) Dental Clinic (User Fees) Vaccine Delivery ($ Per Dose) (Influenza/Hep B/HPV) Cost-Shared Programs 100% Programs No cost shared fiscal year programs Fiscal year programs (Apr-Mar) tyketalk (MCYS) Infant Hearing Prg. (MCYS) Blind Low Vision (MCYS) Smart Start for Babies (Federal) 6
2012 Health Unit Budget Cost Shared Total $23 million 100% Funded Total $8.8 million $ 31.8 million Total 2012 Budget Total Public Health Funding by Funding Body (%) Mandatory (Cost-Shared) Program Funding by Funding Body (%) 7
HPPA Section 72(1) (Payment by Obligated Municipalities) The obligated municipalities in a health unit shall pay, (a) the expenses incurred by or on behalf of the board of health of the health unit in the performance of its functions and duties under this or any other Act; and b) the expenses incurred by or on behalf of the medical officer of health of the board of health in the performance of his or her functions and duties under this or any other Act. 1997, c. 30, Sched. D, s. 8. HPPA - Section 76 (Provincial Funding Obligations) The Minister may make grants for the purposes of this Act on such conditions as he or she considers appropriate. 1997, c. 15, s. 5 (2). Public Health Accountability Agreement The contract between each board of health and the Province of Ontario to fulfill all duties and responsibilities assigned to boards of health under the Health Protection and Promotion Act, including compliance with the Ontario Public Health Standards and the Ontario Public Health Organizational Standards. Signed by Board of Health Chair September 2011 8
Middlesex-London Board of Health Roles and Responsibilities Summary 1. Legislatively constituted body 2. Legislatively mandated to provide specific public health programs and services 3. Legislatively responsible for the governance and administration of the Public Health Unit 4. Legislatively authorized to determine annual municipal funding level History of Current Budget Situation Funding History Pre 1998 75% Provincial 25% Municipal 1998 100% Municipal 1999 50% Provincial 50% Municipal 9
SARS - 2003 Federal and Provincial Reviews of Public Health Response conducted in 2004 Justice Campbell Report SARS showed that Ontario s public health system is broken and needs to be fixed. Despite the extraordinary efforts of many dedicated individuals and the strength of many local public health units, the overall system proved woefully inadequate. Provincial Response to SARS Reviews Recommendations A commitment to strengthen Public Health by increasing the total funding available for Public Health in order to improve local Public Health capacity and a commitment to increase the provincial portion of the cost shared arrangement with municipal funders. 10
Proposed Provincial Funding Arrangement Transition 2005 55% Provincial 45% Municipal 2006 65% Provincial - 35% Municipal 2007 75% Provincial 25% Municipal 2005 Board of Health Business Plan - Objective To enhance local Public Health programs and services on an ongoing basis through annual Provincial grant increases with no increase in Municipal funding (using 2004 as the base year) until a 75% Provincial / 25% Municipal cost-sharing arrangement is achieved. Board of Health Business Plan Rationale 1. The change in the provincial/municipal funding formula is intended to increase resources for public health to address the deficiencies identified by the Provincial SARS Response Reviews. 2. There is no increase in the funding allocated by either the City or the County from that designated by both in 2004. 11
Board of Health Business Plan - Rationale 3. The Middlesex-London Health Unit on a per capita funding basis is 34th of 36. 4. Funding increases to the Middlesex-London Health Unit have not kept pace with the provincial average over the past five years. Board of Health Business Plan - Implementation Approved by City Council and County Council each year since 2005 Success of Board of Health Business Plan 2004-2011 Cost-Shared Program Funding ($000 s) by Funding Source $25,000 $13,690 $14,324 $14,964 $14,834 $15,265 $20,000 $9,279 $11,390 $15,000 $7,373 Increase of $7.9 million over 7 years Province of Ontario Middlesex County $10,000 City of London $5,000 $1,180 $1,180 $1,180 $1,180 $1,180 $1,180 $1,180 $1,180 $6,195 $6,195 $6,195 $6,195 $6,195 $6,195 $6,195 $6,195 No change over 7 years $- 2004 2005 2006 2007 2008 2009 2010 2011 12
2003 Public Health Funding Transition R: 50/50 A: 50/50 SARS 2004 R: 55/45 A: 55/45 2005 R: 65/35 A: 62/38 2006 Provincial Grant 5% Max (Cap) R: 75/25 A: 66.3/33.7 R: 75/25 A: 66/34 2008 5% Provincial / 0% Municipal 2007 R: 75/25 A: 67.2/32.8 R: 75/25 A: 66.6/33.4 2011 R: 75/25 A: 67.2/32.8 2010 2009 Provincial Grant 3% Max (Cap) & Loss of PHRED funding R = Requested (Board) A = Approved (Provincial) 3% Provincial / 0% Municipal $7.9 M in Provincial Funding 13